I don't use an ASV either. I have advocated for many to get one.
I'm confident an ASV, when tuned, would most likely treat your apnea to a level between 0 and 1 with zero not being an uncommon result.
I'm also confident that learning to use an ASV is difficult, but ASV users usually say it was worth it. Occasionally individuals don't like the wide pressure swings that can and do occur on a breath by breath basis.
ResMed doesn't even report Central Apneas because it corrects them mid breath.
I also wouldn't be surprised if you need separate settings for 500 ft and 5000 ft. This would go for any CPAP though the ASV would be the least likely to require this because of its aggressive response to events in the forming.
How to choose.
How do you feel with your current therapy? What do you feel needs improving? Numbers are not allowed in your answer (Though I do understand that zeros feel awful good).
For example, based on responses posted in this forum, I strongly suspect that Sierra is comfortable with her current level of therapy and therefore I wouldn't suggest an ASV. Her CA numbers are fairly stable.
I frequently see CA number that I describe as Consistently Inconsistent. That is that they range from very good to very bad and there is nothing happening that would seem to be a cause for the variation. Usually much effort has been expended to minimize the Central events. This person is likely to benefit from an ASV.
To Qualify, this is what MediCare looks for. Most insurance companies follow the MediCare guidelines
Complex Sleep Apnea
For Complex Sleep Apnea the Medicare requirements for issuing an ASV machine.
*Titrate to minimize OSA, that is the obstructive AHI to less than 5 per hour. This typically is raising EPAP or pressure until obstructive AHI is less than 5 per hour, we expect this to make the Central and Complex Apnea worse thus failing the current treatment
*Record the central apnea-central hypopnea index (CAHI) (looking for greater than or equal to 5 per hour and greater than 50% of total AHI)
*Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.
-Sleepiness, "How do you feel?"
-Awakening short of breath, "How do you feel?"
-Difficulty initiating or maintaining sleep, "How do you feel?"
-Frequent awakenings, or "How do you feel?"
-Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing
-Snoring, Can be documented on OSCAR
-Witnessed apneas Most of us have this one with our significant others
